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. 2021 Sep 1;118(12):2582–2595. doi: 10.1093/cvr/cvab287

Table 1.

Comparison of pros and cons related to various imaging modalities available for the detection and initial evaluation of AAA

Pros Cons
Duplex ultrasound

  • Inexpensive

  • Contrast sparing

  • First-line for identifying AAA—Sn/Sp approaches 100%40,41

 Operator dependent, may be limited by habitus (obesity), bowel gas (fasting):

  • Orthogonal measurement in systole and anterior-posterior direction needed for accurate sac size

  • Need to define the extent of the aneurysm

  • Iliac imaging needed

  • Inadequate for operative planning
CT angiography Gold standard for pre-op planning:

  • EVAR eligibility

  • Anatomy

  • Sizing of endograft

  • Contrast exposure

  • 2D measurements alone may lead to error (3D reconstruction, centre line measurements may not be available everywhere)3
MR angiography Pre-op planning possible:

  • EVAR eligibility

  • Anatomy

  • Sizing of endograft

  • Less useful for initial diagnosis

  • Expensive

  • Motion artefact

  • GDCA use

  • NSF—macrocyclic ionic GBCA agents low risk
Catheter-based angiography

  • IVUS

  • CO2 angiography?

    • Available in specialized centres

    • Not above the diaphragm

  • Luminogram—not accurate to determine AAA size, thrombus, plaque, or calcification as an initial test

AAA, abdominal aortic aneurysm; CO2, carbon dioxide; GDCA, gadolinium-based contrast agent; IVUS, intravascular ultrasound; NSF, nephrogenic systemic fibrosis; Sn/Sp, sensitivity/specificity.